Regenerative effect of comprehensive physiotherapeutic programs in the early postoperative period in patients with chronic paraproctitis

Abstract

To study the role of the medical rehabilitation program in the early postoperative period on the adequate scar formation and postoperative wound healing processes (by transrectal ultrasound investigation and scar tissue sonoelastography) as well as postoperative complications rate and long-term (up to 12 months) treatment outcomes in patients with chronic paraproctitis. The study included 60 patients 20-69 years with chronic pararectal fistulas (ICD-10: K60.4). The patients were assigned into two groups. The control group consisted of 30 patients who received standard of care in the early postoperative period, including analgesics, local antibacterial ointments (Levomekol, etc.), and rectal suppositories (Relief Pro, etc.). The main group also consisted of 30 patients who received standard of care and a 5-day comprehensive physiotherapeutic program starting the second day after the surgery. Effectiveness was assessed by complex transrectal ultrasound investigation with color Doppler mapping, Doppler sonography, and sonoelastography at various post-surgery time points. The higher efficacy of the rehabilitation program, including intravenous ozone therapy, rectal laser therapy, recto-tibial myostimulation, and biofeedback therapy in the early postoperative period, versus the standard of care, was shown. The introduction of rehabilitation program including intravenous ozone therapy, rectal laser therapy, recto-tibial myostimulation, and biofeedback therapy in the early postoperative period significantly reduced the average postoperative wound healing time by accelerating the formation of an adequate scar (according to transrectal ultrasound investigation and scar tissue sonoelastography) and the incidence of postoperative complications and improved the long-term treatment outcomes (up to 12 months) in patients with chronic paraproctitis.